Depression in Pregnancy

           

Mental health treatment is imperative for all but even more so for pregnant and post-

partum women(Depression in Pregnancy Discussion Essay Example).  Their mental and physical health impacts every aspect of their child’s life.  The

Edinburgh Postnatal Depression Scale (EPDS) is a valid evidenced based screening tool for

pregnant and postpartum women (Barassi & Grealish, 2022).  The EPDS is a quick 10 item self

reported questionnaire.  Scores greater than or equal to 12 are equivalent to a high risk of

depression (Barassi & Grealish, 2022).   Barassi & Grealish (2022) recommend decreasing the

high risk criteria to greater than or equal to 9 for adolescents as the standard criteria does not

capture all possibly depressed pregnant and postpartum adolescents.  All patients whom are

pregnant should have mental health screenings as part of their medical visits.  When

considering treatment of depression in pregnancy providers are charged with fully informing

their patients of the risks to themselves and their babies of treated and untreated maternal

depression. All safe options should be considered, including medication without stigma or

judgment being placed on the patients.(Depression in Pregnancy Discussion Essay Example)

                                                       FDA Approved Medication

            Sertraline is an FDA approved medication utilized to treat depression (Stahl, 2021). 

There is currently no FDA approved medication specifically to treat depression in pregnancy. 

Sertraline is the most studied and prescribed antidepressant in pregnancy (Patatanian &

Nguyen, 2022). The FDA is currently working on a sertraline dosing model for clinicians to utilize

with their pregnant patients (FDA, 2021). I would utilize sertraline on my pregnant patients

who become depressed.  Rare side effects to be mindful of include: seizures, induction of

mania and activation of suicidality (Stahl, 2021)(Depression in Pregnancy Discussion Essay Example).   If patients are currently prescribed

medication for depression and it is effective I would maintain that treatment. It is

recommended to continue a patient’s effective medication during pregnancy and not

switch to alternatives (Misri, Kostaras, & Milis, 2005, Molenaar, Kamperman, Boyce, & Bergink,

2018). Polypharmacy is also discouraged to limit possible side effects on the patient and fetus

(Misri, Kostaras, & Milis, 2005, Molenaar, Kamperman, Boyce, & Bergink, 2018).  If a patient

develops post partum depression I would utilize brexanolone as it is the only FDA approved

medication for post partum depression (Stahl, 2021).  This is a short term treatment requiring

medically supervised infusions (Stahl, 2021).  Brexanolone is effective but it is expensive and

time consuming as it must be administered IV in the hospital over 60 hours (Patatanian &

Nguyen, 2022). (Depression in Pregnancy Discussion Essay Example)          

                                                      Off Label Medication

            One medication that I have seen utilized off label to treat patients whom are depressed

in pregnancy is buspar.  Buspar is FDA approved to treat anxiety (Stahl, 2021).  It is used off

label to treat depression and treatment resistant depression (Stahl, 2021).  Buspar is not

recommended for patients with renal or hepatic impairments (Stahl, 2021).  Adverse effects

were not found in patients utilizing buspar even during the first trimester (Freeman, et.al.,

2022). Adverse effects were also not found in animal studies (Stahl, 2021). (Depression in Pregnancy Discussion Essay Example)

                                                   Non pharmacological Interventions

            Psychotherapy is often recommended as a monotherapy or in conjunction with

pharmacotherapy.   Psychotherapy is recommended for pregnant women whom are diagnosed

with depression (Yonkers, et., al., 2009).  This is especially helpful as antidepressants are

discontinued during this timeframe more than any other pharmacotherapy (Germack, 

Combellick, Cooper, Koller, & McMichael, 2022).   Cognitive Behavioral Therapy is

recommended especially as initial treatment for mild to moderate depression (Molenaar,

Kamperman, Boyce, & Bergink, 2018).  CBT via telehealth has proven to be effective as well

(Yonkers, et., al., 2009). (Depression in Pregnancy Discussion Essay Example)

           Electroconvulsive Therapy (ECT) can be utilized for patients with severe depression that

is not responsive to pharmacotherapy and psychotherapy (Yonkers, et., al., 2009).  ECT requires

medical monitoring of the patient and fetus (Yonkers, et., al., 2009).

           Exercise is also recommended as treatment for depression in pregnancy.  A variety of

exercises including: yoga, walking, stretching, aquatics, aerobics, strength training, and mixed

exercise classes have been associated with reductions in depression and anxiety in pregnancy

(Jarbou & Newell, 2022).(Depression in Pregnancy Discussion Essay Example)                  

                                                        References

Barassi, F., & Grealish, A. (2022). Validity of the Edinburgh Postnatal Depression Scale for

    screening pregnant and postpartum adolescents: a systematic review. Australian Journal of

    Advanced Nursing, 39(2), 65–75. https://doi.org/10.37464/2020.392.446

Freeman, M., Szpunar, M., Kobylski, L., Harmon, H., Viguera, A., & Cohen, L. (2022). Pregnancy

    outcomes after first-trimester exposure to buspirone: prospective longitudinal outcomes

    from the MGH National Pregnancy Registry for Psychiatric Medications. Archives of women’s

    mental health, 25(5), 923–928. https://doi.org/10.1007/s00737-022-01250-8

Germack, H., Combellick, J., Cooper, M., Koller, K., & McMichael, B. (2022). Antidepressants are

    the most commonly discontinued psychotherapeutic medications in pregnancy. Women’s

    Health Issues, 32(3), 241–250. https://doi.org/10.1016/j.whi.2021.10.004

Jarbou, N., & Newell, K. (2022). Exercise and yoga during pregnancy and their impact on

    depression: a systematic literature review. Archives of Women’s Mental Health, 25(3), 539–

    559. https://doi.org/10.1007/s00737-021-01189-2

Misri, S., Kostaras, X., & Milis, L.  (2005). The use of antidepressants in pregnancy and lactation. 

    BCMJ, 47(3), 139-142. 

Molenaar, N., Kamperman, A., Boyce, P. & Bergink, V.  (2018). Guidelines on treatment of

    perinatal depression with antidepressants: An international review.  Aust N Z J Psychiatry,

    52(4), 320-327.  Doi: 10.1177/0004867418762057

Patatanian, E., & Nguyen, D. (2022). Brexanolone: A novel drug for the treatment of Postpartum

    Depression. Journal of Pharmacy Practice, 35(3), 431–436.

https://doi.org/10.1177/0897190020979627

Stahl, S. (2021). Essential psychopharmacology prescribers guide. (7th ed.).

    Cambridge University Press.(Depression in Pregnancy Discussion Essay Example)

U.S. Food & Drug Administration. (2021). Physiologically based pharmacokinetic modeling of 

    sertraline dosing in pregnancy.  Retrieved on April 24, 2023 from https://www.fda.govLinks to an external site.

•     /drugs/regulatory-science-research-and-edu

Depression in Pregnancy Discussion Essay Example

Response to Colleague

Great post! Thank you for sharing your discussion on depression in pregnancy. Your discussion was informative and engaging, touching on crucial mental health issues during pregnancy. Mental health is a vital component in prenatal and post-natal care(Depression in Pregnancy Discussion Essay Example). A mother’s mental health affects the fetus’s physical and mental development. Thus, frequent mental health screening promotes early identification and management of mental illnesses, thus improving birth outcomes. Appropriate pharmacological and non-pharmacological interventions should be adopted to treat depression among pregnant women. FDA-approved medications should be used without potential side effects on the mother, fetus, or newborn. However, not FDA-approved medications should be used when there are no other alternatives and with the required precautions. (Depression in Pregnancy Discussion Essay Example)
One FDA-approved medication I would administer to a pregnant woman to treat depression besides Sertraline is escitalopram. The medication is a serotonin reuptake inhibitor and one of the first lines of treatment for anxiety and depression. Escitalopram medication is effective in managing depression among pregnant women. It is only linked to risks of low birth weights compared to other drugs, such as bupropion, that are linked with detrimental birth outcomes such as respiratory distress and seizures (Anderson et al., 2020)(Depression in Pregnancy Discussion Essay Example). One offer-label medication that can be used is venlafaxine. A research study on the maternal use of antidepressants showed that venlafaxine caused the highest rates of congenital disabilities compared to escitalopram (Anderson et al., 2020). Fully-informed health decisions should balance the risks and benefits of the proposed medications against the fetal and maternal risks of untreated depression. The healthcare professional should remember that all pregnancies have underlying congenital disabilities risks regardless of the medication choice. Besides psychotherapy, psychological counseling and psychosocial intervention can aid in managing depression. Psychosocial counseling improves women’s ability to cope with pregnancy and motherhood while offering psychological and social support to promote their mental well-being (Lu et al., 2023). Subsequently, relaxation techniques such as Yoga can help to relieve mild to moderate depression among pregnant women. (Depression in Pregnancy Discussion Essay Example)

References

Anderson, K. N., Lind, J. N., Simeone, R. M., Bobo, W. V., Mitchell, A. A., Riehle-Colarusso, T., … & Reefhuis, J. (2020). Maternal use of specific antidepressant medications during early pregnancy and the risk of selected birth defects. JAMA psychiatry, 77(12), 1246-1255.(Depression in Pregnancy Discussion Essay Example)
Lu, X., Yang, Z., Liu, F., Zhou, Y., Xu, Y., Zhuo, Y., … & Gong, M. (2023). Effectiveness of non-pharmacological treatments for postpartum depression: an umbrella review protocol. BMJ open, 13(1), e066395.

Frequently Asked Questions

Is depression a normal part of pregnancy?

Depression can occur during pregnancy, but it is not considered a normal or typical part of the experience. While mood changes and hormonal shifts are common during pregnancy, persistent and severe symptoms of depression should be addressed with medical professionals to ensure the well-being of both the expectant mother and the baby.(Depression in Pregnancy Discussion Essay Example)

What kind of depression do you have while pregnant?

Depression during pregnancy, known as antenatal or prenatal depression, is a mood disorder that can affect expectant mothers. It involves persistent feelings of sadness, loss of interest or pleasure, changes in appetite or sleep patterns, and can impact the well-being of both the mother and the developing baby. It is essential for pregnant individuals experiencing depressive symptoms to seek support and guidance from healthcare professionals.(Depression in Pregnancy Discussion Essay Example)

How does sadness affect a baby in the womb?

Sadness experienced by a pregnant mother can potentially impact a baby in the womb due to the release of stress hormones like cortisol, which may cross the placenta and affect fetal development. Prolonged or severe maternal sadness could potentially contribute to an increased risk of preterm birth, lower birth weight, and even subtle emotional or behavioral changes in the child after birth. However, the exact extent of these effects can vary based on individual circumstances and should be considered within a broader context of maternal well-being and support.(Depression in Pregnancy Discussion Essay Example)

What is the meaning of depression in pregnancy?

Depression in pregnancy, also known as antenatal or prenatal depression, refers to the presence of significant and persistent feelings of sadness, hopelessness, and a lack of interest or pleasure during the course of pregnancy. It can impact the emotional well-being of the expectant mother and may have implications for both her and her baby’s health. Seeking appropriate support and treatment is important to address this condition and promote a healthier pregnancy experience.(Depression in Pregnancy Discussion Essay Example)